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Public and Private Purchasers and Insurers

Advance guidelines-based care to avoid the costly repercussions of poor asthma management.

The Institute of Medicine identified a “chasm” in our health care system between the quality of care delivered and the quality of care patients should expect to receive based on the best scientific knowledge. In asthma, the gap between evidence-based best practice and what is covered by insurers, required by purchasers, and delivered by providers is just as wide.

Poorly managed asthma burdens everyone. It leads to nearly 1.7 million visits to emergency departments[1] and 444,000 hospitalizations[2] annually in the United States. The cost of hospitalizations alone amounts to 15%[3] to 35%[4] of total direct medical expenditures for asthma. (See sources at bottom of this page)

Fortunately, most emergency department visits, hospitalizations, and deaths due to asthma are avoidable through the consistent application of evidence-based asthma guidelines. As a health insurer or purchaser of health care benefits, you can use these guidelines to create a high-performing health care system that promotes clinical effectiveness, access to preventive care services, and organizational capacity to improve patient outcomes and satisfaction.

Reorganize care delivery to improve quality and value.

Research clearly shows that reorganizing how chronic care is delivered can improve outcomes and reduce disparities. For asthma, it can be cost-effective too. Evidence-based asthma care provides the best value by improving outcomes at a reasonable cost when compared with “usual care.” Cost savings from evidence-based asthma care also is possible, particularly for high-risk groups that achieve significant reductions in hospitalizations and emergency department visits.

Additional benefits of evidence-based asthma care include increased satisfaction with health plans and care delivery, more appropriate utilization of health care services, and increased employee productivity or reduced absenteeism. Other less tangible benefits, such as enabling patients with asthma to engage in their usual daily activities, may be harder to quantify.

Apply evidence for systems improvement.

The NAEPP’s Guidelines Implementation Panel (GIP) Report: Partners Putting Guidelines Into Action recommends that public and private purchasers of health care services identify and remove barriers to the delivery of guidelines-based care and effective patient-self management. Examples include minimizing out-of-pocket expenses for patients with asthma; reimbursing for patient education, care coordination, and case management; offering provider performance incentives linked to quality care and outcomes; and ensuring that formularies include appropriate asthma medications and devices.

The GIP Report offers the following tips and many more recommended strategies for public and private payers, commercial and public health plans, employer coalitions, provider organizations, health benefits managers, disease management firms, electronic health record companies, and policymaking agencies to redesign systems for effective patient-centered, culturally appropriate quality asthma care.

  1. Monitor asthma care processes, quality, and outcomes and share results.
  2. Use information technology to improve clinical support and information flow.
  3. Build knowledge, skills, and cultural competencies of health care team members.
  4. Set performance standards and provide incentives for evidence-based quality care.
  5. Ensure full access to specialists, support services, and asthma medications and devices.

More info:

Sources:

  1. Centers for Disease Control and Prevention. National Center for Health Statistics. National Ambulatory Medical Care Survey, 1992-2006. National Hospital Ambulatory Medical Care Survey, 2006. Cited by: American Lung Association. Trends in Asthma Morbidity and Mortality 2009 (January 2009).
  2. DeFrances CJ, Lucas CA, Buie VC, Golosinskiy A. 2006 National Hospital Discharge Survey. National health statistics reports; no 5. Hyattsville, MD: National Center for Health Statistics. 2008.
  3. Cisternos M et al. A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol. 2003 June; 111(6):81212-1218.
  4. National Heart, Lung and Blood Institute. Morbidity and Mortality: 2009 Chartbook of Cardiovascular, Lung and Blood Diseases. Bethesda (MD): National Institutes of Health, 2009.

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Last Updated February 2011




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